This presentation is created by Face Art International Cosmetic Super speciality for “Patient education purpose”. This presentation is presented by Dr. Amit T. Suryawanshi (Oral & Maxillofacial plastic Surgeon, Dental Surgeon & Hair Transplant Specialist from University of Greifswald, Germany) at National & International level in the field of above mentioned Specialities. Hope this would somehow be helpful to you while making your presentations. All the best & your replies will be welcomed! Follow us for Future Journey towards betterment of Humanity.

1. Advanced
Treatments for
Reduced
Mouth
Opening
Created & Presented at International Conference by
Dr. Amit T. Suryawanshi
Oral Submucous Fibrosis

2. Most of the times Patients are very
much worried about their
“ Reduced Mouth opening ” problems
&
They have a Question like this
Is it going to be Normal like before ??
Answer is Yes ..why not?

3. First you need to
understand
what it is
It is
Oral Submucous Fibrosis
Fibrous bands inside your mouth’s skin
(mucosa) restricting your mouth opening

4. Created & Presented at International Conference by
Dr. Amit T. Suryawanshi
(MDS) Facial Cosmetic Surgeon
Oral & Maxillofacial Surgeon
Dental Surgeon & Implantologist
Hair Transplant Surgeon (Germany)
Consulting Surgeon in Kolhapur, Sangli, Pune & Mumbai (India)
&
founder of
Face Art International Super speciality
at Kolhapur (India)
Oral Submucous Fibrosis - Advanced Treatments

5. • Dr. Amit T. Suryawanshi has published various
articles in many national & International Journals
regarding Oral Sub mucous Fibrosis & other
topics in the field of Maxillofacial Plastic
Surgery, Advanced Hair Transplant & Advanced
dentistry .
(MDS) Facial Cosmetic Surgeon
Oral & Maxillofacial Surgeon
Dental Surgeon & Implantologist
Hair Transplant Surgeon
(Germany)
Know Your Doctor

6. We respect patient’s confidentiality. So we don't share
any of the following.
Name, Age , Sex ,Address, Photographs, Phone no. or
Any information of the patient .
Total number of
Operated Cases at our
Centre
(Till 30th April- 2016)
945
Average Mouth opening
Before operation 8 mm
Average Mouth opening
After operation 45 mm
Success Rate 100 %

7. (J.J Pindborg 1966)
“ It is an insidious chronic disease affecting any part of the oral cavity
and sometimes the pharynx. Although occasionally preceded by or
associated with vesicle formation ,it is always associated with juxta-
epithelial inflammatory reaction followed by a fibro-elastic changes of
the lamina propria with epithelial atrophy leading to stiffness of the oral
mucosa and causing trismus and inability to eat.”
It is considered to be POTETIALLY MALIGNANT DISORDER .
DEFINITION
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8. • OSMF is a crippling fibrotic disorder seen commonly in
India and Indian subcontinent & also in Malaysia, Nepal,
Thailand and South Vietnam.
• Population between 20 to 40 years of age are most
commonly affected .
• Occurrence of OSMF in India is 0.2-0.5% of population.
EPIDEMIOLOGY

9. Etiology of OSMF:
Exact etiology is unknown. The predisposing factors are,
1. Chronic Irritation
- Chilies, Lime, Areca nut, Tobacco.
2. Defective iron metabolism
3. Bacterial Infection
4. Collagen disorder
5. Immunological disorders
7. Genetic disorder.

10. Chronic irritation:-
• Pathogenesis of OSMF lies in the continuous action of mild
irritants.
Chillies:-
• "Capsaicin" an active extract from capsicum.
• The active principle irritants of chillies (Capsicum annum
and Capsicum frutescence) .

11. Areca nut –
It contains,
• ARECOLINE, ARECAIDINE
-Fibroblast proliferation
-Stimulate collagen synthesis
• TANNIN, CATHECHIN-
- Makes collagen fibrils resistant to
collagenase.

12. • The data regarding the sex predilection is conflicting.
Earlier it was thought to be common in females.
• But at present, study ratio shows 2.3: 1=M:F
• Age group - 2nd to 4th decade of life.
CLINICAL FINDINGS

13. Prodromal symptoms
Initial symptoms Later
Burning sensation on eating
spicy food
Blisters on the palate
Ulceration or recurrent
stomatitis
Excessive salivation
Defective gustatory sensation
Dryness of mouth.
Difficulty in opening mouth
Inability to whistle, blow
Difficulty in swallowing
Referred pain to the ear
Changes in tone of the voice
due to vocal cord involvement
Sometimes deafness due to
occlusion of eustachian tubes

14. COMMON SITES INVOLVED-
• Buccal mucosa, faucial pillars, soft palate, lips and hard palate.
• The fibrous bands in the buccal mucosa run in a vertical
direction, sometimes so marked that the cheeks are almost
immovable.
• In the soft palate the fibrous bands radiate from the
pterygomandibular raphe or the faucial pillars and have a scar
like appearance.

15. • The uvula is markedly involved, shrinks and appears as a
small fibrous bud.
• The faucial pillars become thick, short, and extremely hard.
• The tonsils may be pressed between the fibrosed pillars.
• The lips are often affected and on palpation, a circular band
can be felt around the entire lip mucosa.
• When gingiva is affected, it is fibrotic, blanched and devoid
of its normal stippled appearance.

16. Staging of OSMF:
• Stage I : Stage of stomatitis & vesiculation
• Stage ll : Stage of fibrosis
• Stage III :Stage of sequelae and complication
(Ref -Pindborgh JJ-1989)

17. Stage I : Stomatitis & vesiculation
Stomatitis includes erythmatous mucosa,
vesicles, mucosal ulcers,melanotic mucosal
pigmentation.

18. Stage II: (Fibrosis):-
• There is inability to open mouth completely and stiffness in
mastication. As disease advances there is difficulty in blowing
out cheek & protruding tongue. Sometimes pain in ear and
speech is affected. On examination there in increasing amount
of fibrosis in the submucosa. This causes blanching of mucosa.
• Lips & checks become stiff & lose their normal resistance.
Shortening & disappearance of uvula in advanced cases.
• Mucosa of floor of mouth show blanching & stiffness

19. Stage III (Sequelae & Complication)
• Patient presents with all the complaints as in stage II. Also
there may be evidence of leukoplakia.
• Changes in mucosa are whitish or brownish black.
• Pindborg et al (1967) found that OSMF was found in 40%
cases of oral cancer than in general population (1.2%).

20. Recent classification for OSMF
- Chandramani More et al 2011
• Clinical staging –
S1 -Stomatitis or blanching of oral mucosa
S2 –Presence of fibrous bands over buccal mucosa,
oropharynx with or without stomatitis.
S3 - Presence of fibrous bands over buccal mucosa,
oropharynx and any part of oral cavity with or
without stomatitis.

21. • S4 a –
Anyone of above stage with potentially
malignant disorders
Eg- leukoplakia, erythroplakia.
• S4 b –
Anyone of above stage with oral carcinoma

22. Recent classification for OSMF
Chandramani More et al 2011
Functional staging -
M1- Interincisal mouth opening upto or > 35 mm
M2- Interincisal mouth opening between 25-35 mm
M3 - Interincisal mouth opening between 15-25 mm
M4 - Interincisal mouth opening <15 mm

23. DIAGNOSIS IS BASED ON :
 Clinically appreciable blanching and pallor.
 Palpable bands and restriction-of mouth opening.
 Severe burning sensation of mouth, aggravated by use of
even moderate spicy food.
 Biopsy report.

24. Histopathological findings -
• Atrophic Oral epithelium.
• Loss of rete pegs .
• Epithelial atypia may be observed.
• Hyalinization of collagen bundles.
• Fibroblasts decreased and blood vessels obliterated.

25. MANAGEMENT -
Various modalities of treatment have been tried.
1.Restriction of habits/ Behavioral therapy.
2.Non-surgical therapy.
3.Surgical therapy.
4.Oral Physiotherapy.

26. Restriction of habits/behavioral therapy-
 The consumption of pan, betel nut, chillies, spices, &
commercially available, pan masalas, guthkas with or
without tobacco is increasing . So people should be
encouraged to stop these habits.
 Affected patients should be explained about the disease and
possible malignant potential of OSMF.
 Possible irritants should be removed.
 Nutritional supplements.

27. NON-SURGICAL THERAPY
• Antioxidants
• Intralesional injections of Hyaluronidase.
40 mg of triamcinolone acetonide is injected submucosally into
faucial pillars, retro-molar area and buccal mucosa.
• Intralesional injections of Hydrocortisone
On average 150 to 200 mgs of corticosteroids are injected in
divided doses at 10 days interval for a period of 2 to 3 months.

28. Use of Placentrix 2ml solution at interval of 3 days.
The human placental tissue extract has growth stimulation
effects and also development of immune system. This contains
water soluble factors which are growth stimulant for
keratinocytes. It increases hummoral immune mechanism by
increase in IgM levelsslecific for bacterial toxins
It contains nucleotides, vitamins , amino acids, fatty acids and
trace elements. Vitamins present are vitamin E, B1, B2,
pantothenic acid, B6, nicotinic acid, biotin, P aminobenzoic acid,
folic acid, B12, choline inositol.

29. Topical application
4% Acetic acid (At PH 6.5) 3 times daily.
4% acetic acid has capability of solubilizing
cross-linked molecules in collagen and it
causes collagenolysis.

30. SURGICAL TREATMENT -
Fibrotomy (scalpel, electrocautery, laser)
Coronoidectomy & Temporalis myotomy
• Extraction of all third molars
Reconstruction
with
(Bilateral nasolabial flaps, Pedicled tongue flaps, Buccal fat pad, Split
thickness skin grafting, Collagen membrane & Temporalis fascia)

31.  Cryosurgery
 Laser treatment
& Many other advanced treatments
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32. Dr. Amit T. Suryawanshi’s
Record of Oral Sub-mucous fibrosis Treatments.
Total Operated
Cases at our Centre
(Till 30th April- 2016)
945
Average Mouth opening
Before operation 8 mm
Average Mouth opening
After operation 45 mm
Success Rate 100 %

33. Patients from other parts of the world
Total number of
Operated Cases at our
Centre
(Till 30th April- 2016)
945
Patients from USA 21
Patients from Europe 8
Patients from Asia
(China, Singapore, Myanmar,
Malaysia, Maldives, Mongolia,
Nepal)
38
Success Rate 100 %

34. We achieve 100% Successful & Permanent Results
by doing
Advanced Treatments of Oral Sub-mucous fibrosis.
Only things needed from patients are…
• Trust
• Ability to drop the habit of Chewing & other
addictions.
• Exercises (Physiotherapy) after Surgery or
Medicinal Treatment.
• Regular follow up visits
• Consistency & Dedication.

35. Feel
Free
to
Ask
anythingQuestions ??

36. Face Art International
Super Speciality
Address : Face Art International "Renuka Sadian",First floor,
Above Kallappanna Awade Bank, Near Allen Solly
Showroom, 6th lane Rajarampuri, Contact us at - 7758976097
Kolhapur. 416 008
•
Email ID - amitsuryawanshi999@gmail.com
dramit@faceart-clinic.com
Cell phone +91 9405622455
If you are an International patient kindly dial +91 before
number
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37. Future belongs to those
who believe in beauty of their
Dreams
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38. Follow us on SlideShare &
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